Katarzyna Kotfis

Background: Non-invasive ventilation (NIV) is a well-established approach for preventing endotracheal intubation (ETI) in critically ill patients with acute respiratory failure (ARF). Sedation is frequently used to improve comfort. This study aimed to analyze the impact of sedation during NIV on ETI rates and NIV success in critically ill patients. Methods: We systematically searched in PubMed, EMBASE, MEDLINE, Web of Science, and CENTRAL up to September 2023, including prospective observational studies, retrospective cohort studies (nRCTs), and randomized controlled trials (RCTs). Primary outcomes were NIV success and ETI rates; secondary outcomes were hypotension, bradycardia, 28-day mortality, delirium, and oversedation. Proportions were used for observational studies, odds ratios (OR) for retrospective studies, and risk ratios (RR) for RCTs. Retrospective studies compared intermittent and continuous analgosedation, while RCTs evaluated dexmedetomidine versus other sedatives, including direct comparisons. Results: Four observational studies, 2 retrospective studies, and 7 RCTs (738 patients) were selected. Dexmedetomidine showed increased NIV success (RR = 1.167, 95%C.I. 1.014–1.343, p = 0.032) and reduced ETI rate (RR = 0.553, 95%C.I. 0.405–0.755, p < 0.001), but higher rate of bradycardia (RR = 2.172, 95%C.I. 1.819–4.042, p < 0.001) and hypotension (RR = 2.441, 95%C.I. 1.608–3.706, p < 0.001). nRCTs revealed higher NIV success (Proportion = 0.694, 95%C.I. 0.528–0.912, p = 0.009), moderate ETI rates (Proportion = 0.379, 95%C.I. 0.282–0.511, p < 0.001), and low bradycardia and hypotension rates. Conclusions: Our findings suggest that sedation, particularly dexmedetomidine-based strategies, may enhance NIV success and lower ETI rates. However, dexmedetomidine was also associated with higher rates of bradycardia and hypotension, especially compared with midazolam. To establish the correct sedation strategy, it is important to tailor the drug to the patient, considering its hemodynamic instability, delirium risk, and mortality risk.

Background/Objectives: Cardiac arrest (CA) continues to be one of the leading causes of mortality and long-term neurological disability worldwide. Accurate early neuroprognostication after return of spontaneous circulation is essential for guiding post-resuscitation care. The calcium-binding astrocytic protein S100B has been identified as a potential biomarker for hypoxic–ischemic brain injury. This systematic review and meta-analysis assessed the prognostic and diagnostic efficacy of serum S100B in forecasting neurological outcomes after CA. Methods: Thorough searches of PubMed, Embase, Scopus, Web of Science, CENTRAL, and CINAHL from their inception to November 2025 uncovered 40 observational studies. Results: Pooled analyses employing random-effects models revealed markedly reduced S100B concentrations in patients with favourable neurological outcomes compared to those with unfavourable outcomes (standardized mean difference −1.78, 95%CI: −2.25 to −1.31; p < 0.001). The diagnostic accuracy was high, with pooled sensitivity and specificity of 0.63 and 0.93, respectively, and an area under the curve of 0.89 (95% CI 0.85–0.92). Subgroup and sensitivity analyses confirmed the robustness of these findings across various study populations and temporal points, with negligible evidence of publication bias. Conclusions: These results indicate that serum S100B is a reliable early biomarker of neurological prognosis after CA. Incorporating S100B into multimodal predictive frameworks may enhance post-resuscitation decision-making.

Background/Objectives: Atrial fibrillation (AF) is a significant contributor to ischemic stroke; however, existing thromboembolic risk scores exhibit only moderate predictive accuracy. Lipoprotein(a) (Lp(a)), a genetically determined lipoprotein characterized by proatherogenic and prothrombotic properties, may play a role in cardioembolic events in AF. Nonetheless, its clinical relevance in this context remains ambiguous. The goal of this systematic review and meta-analysis was to look at the differences in circulating Lp(a) levels between AF patients who had an ischemic stroke and those who did not, as well as to see if Lp(a) could help figure out who is at risk of thromboembolic events. Methods: A thorough search was performed in PubMed/MEDLINE, Embase, Scopus, Web of Science, and CENTRAL until September 2025, in accordance with PRISMA 2020 and Cochrane Handbook guidelines. Eligible studies encompassed adults with AF and accessible data on Lp(a) concentrations, contrasting individuals with and without ischemic stroke. Results: Five observational studies involving 20,678 atrial fibrillation patients (3104 with ischemic stroke) were incorporated. The pooled analysis revealed markedly elevated Lp(a) concentrations in stroke patients relative to non-stroke controls (MD = 2.42 mg/dL; 95% CI 0.68–4.16; p = 0.007). Conclusions: While Lp(a) testing is not presently endorsed in AF guidelines, our results indicate a possible correlation with ischemic stroke risk. Nonetheless, these findings must be regarded with caution owing to significant heterogeneity, the predominance of Chinese cohorts, and the exceedingly low certainty of evidence as per GRADE assessment. Additional extensive, multi-ethnic, and rigorously designed prospective studies are necessary to ascertain whether Lp(a) constitutes an independent risk factor for ischemic stroke in atrial fibrillation.

Background/Objectives: The most prevalent prolonged cardiac arrhythmia and a significant global health burden is atrial fibrillation (AF). Although its connection to AF is still unknown, lipoprotein(a) (Lp(a)), a genetically determined lipoprotein with pro-inflammatory and pro-atherogenic characteristics, has been linked to cardiovascular disease. The purpose of this study was to measure and assess the relationship between circulating Lp(a) levels and AF. Methods: In compliance with the PRISMA 2020 guidelines, a systematic review and meta-analysis were carried out using a protocol that was preregistered in PROSPERO (CRD420251153244). Comprehensive searches of PubMed/MEDLINE, Embase, Web of Science, Scopus, the Cochrane Library, and Google Scholar up until September 2025 were used to find observational studies comparing circulating Lp(a) levels in adults with and without AF. Results: Circulating Lp(a) concentrations were significantly higher in AF patients than in controls across 10 studies (pooled MD = 2.81; 95%CI: 1.58–4.05; p < 0.0001). In the subgroup analysis by geographical setting, studies conducted in Asia and studies from Europe/USA exhibited a statistically significant effect. Despite the extreme heterogeneity (I² = 99%), sensitivity analyses verified that the overall effect was stable. Conclusions: Our pooled analysis revealed a statistically significant association between Lp(a) and AF; however, the certainty of the evidence was rated as very low according to the GRADE methodology. To elucidate causality, enhance risk stratification, and investigate whether Lp(a)-lowering tactics could alter AF risk, large, prospective, multi-ethnic studies with standardized biomarker assessment are needed.

Background/Objectives: Cardiac surgery, particularly procedures performed with cardiopulmonary bypass (CPB), carries a high risk of neurological complications, including postoperative delirium (POD), which affects 16–73% of patients and increases the likelihood of long-term cognitive impairment. Brain-derived neurotrophic factor (BDNF), a neurotrophin involved in neuronal function, synaptic plasticity, and inflammatory regulation processes, including its Val66Met polymorphism, has been implicated as a potential predictor of POD. This study aimed to evaluate the relationship between perioperative plasma BDNF levels, the BDNF Val66Met polymorphism, and the incidence of POD in patients undergoing elective cardiac surgery with CPB. Methods: This prospective observational single-center study enrolled 287 adults scheduled for elective isolated coronary artery bypass grafting (CABG) with CPB, of whom 107 met all inclusion criteria for final analysis. Exclusion criteria included urgent surgery and pre-existing cognitive or psychiatric disorders. Preoperative evaluation included cognitive testing (MoCA), laboratory and biochemical analysis, and genotyping for BDNF Val66Met. Postoperatively, patients were assessed for POD using the CAM-ICU scale for the first three consecutive days. Cognitive function (using MoCA) and other neurological complications were evaluated during hospitalization, at 30-day and 12-month follow-up. Associations between biomarkers, genetic factors, and clinical outcomes were analyzed. Results: POD occurred in 19.6% of patients who were older, had higher EuroSCORE II, greater coronary disease burden, more frequent prior stroke and chronic kidney disease, and lower neutrophil counts. POD was significantly associated with prolonged hospital stay, need for continuous renal replacement therapy, and reoperation. The BDNF Val66Met polymorphism was present in 31.8% of patients but was not associated with POD, although carriers exhibited higher plasma BDNF concentrations across all time points. Conclusions: Perioperative plasma BDNF concentrations and the BDNF Val66Met polymorphism were not independently associated with the occurrence of POD in elective CABG patients. However, POD was significantly linked to prolonged hospitalization and reoperations. Neurological complications remain an important challenge in cardiac surgery, emphasizing the need for further research and early identification strategies to improve postoperative outcomes.